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October is National Breast Cancer Awareness Month (cont'd)
Ethnic and racial differences exist regarding the incidence of breast cancer. Black women are three times more likely to develop breast cancer than white women; and after the disease has been contracted the death rate among black women also is higher. (3)
It seems to me that breast cancer is only three degrees removed from any of us. Of course, those women who have breast cancer are at ground zero. First-degree separation would be those who have had a primary family member with breast cancer. Second-degree separation describes those who have extended family members with breast cancer, and third-degree separation would be those who know friends, colleagues, or neighbors with this dreaded disease. This seems to account for almost everyone.
Personal Reflection
I am one who, by fate or fortune, is three degrees separated from breast cancer, and it had a devastating effect on me. A very dear friend, who was also a faculty colleague, decided that it was time to retire to the "good life," and so she made plans to do so. After she retired, she and her family intended to travel and see the world. Fate moved in before her retirement, however, when she discovered a breast lump. A lumpectomy was performed, and during surgery, a second lump was found in her other breast. She subsequently underwent many types of treatment, including chemotherapy and radiation. After completing these treatments, she appeared to be cured.
Months later, however, her blood cancer markers skyrocketed, and new masses were identified in her lungs, pancreas, and liver. These were thought to have developed through bloodstream metastasis. Nobody was prepared for how quickly her health deteriorated after this.
By the time her formal retirement drew close, she had developed neurological and sensory impairments, but she insisted on attending a retirement luncheon given in her honor. She also insisted on attending graduation, but this was the last time she was able to leave her bed. My cherished friend died a few weeks after she retired. All who knew and loved her were devastated by her death and by the swift progression of her disease. This incident reaffirmed the seriousness of breast cancer to all of us. This incident also emphasized to me that we must not ignore our own health and that we must be vigilant about self-examinations.
TREATMENTS
Today, patients with breast cancer have more effective treatment options because of the diligent efforts of many researchers. There are many new, non-surgical forms of treatment available for breast cancer. Researchers continually are identifying new medications and noninvasive treatments that are effective against this disease. Surgical procedures range from minimally invasive to the most radical surgery. These procedures include needle-localization biopsies; sentinel lymph node dissections; lumpectomies; quadrantectomies; and mastectomies, ranging from simple to radical dissections. (4) The survival rate for women with breast cancer in 1974 was only 75%. By 2000, however, the survival rate had risen to 88%, and this statistic still is improving today. (1)
Choosing the best treatment option sometimes is extremely difficult for a patient with breast cancer. The information that a physician gives to a patient should be as complete as possible, including all the potential benefits and side effects that a patient might experience. Today, a patient with breast cancer, like any other person seeking medical information, often turns to the Internet. Formal medical web sites along with blogs and personal web sites provide health care information and resources for emotional and social support. It is the responsibility of health care providers to help their patients sort out the valid from the erroneous information that is available.
We, as health care providers, also need to provide culturally relevant care. This should always be considered because in some ethnic populations, it is believed that a patient's family members or a designated family spokesperson should be intimately involved in treatment or non-treatment decisions. As nurses, we can provide recommendations, but it is ultimately the patient who must make the treatment decision.
Implications for Perioperative Nurses
Each day, perioperative nurses are involved in surgical procedures performed to treat patients with breast cancer. This type of surgery is quite common, especially in ambulatory surgery settings, and nurses have the potential to become rather blase about breast cancer. We must never forget the bigger picture of patient support and caring for our patient's emotional needs. A nurse may have little free time during the short preoperative period, but a patient's fear should not be ignored. This is true whether the surgical intervention is quick and simple or a full day's work.
As nurses, it is vital that we provide the highest quality of care to all patients. We also must maintain an ongoing awareness of the special needs of surgical patients with breast cancer. These patients are facing not only the fear of surgery but also the fear of death. My friend told me after her first surgery that the presence of caring and empathetic perioperative nurses made all the difference in the world, and she was so glad to have them by her side as her advocates. I implore all of you to take the time to
* talk with these patients and their family members,
* consider ethnic diversity and provide culturally relevant care, and
* provide the highest level of nursing care that you were educated to give.
During National Breast Cancer Awareness Month, I encourage you to refocus on the needs of your patients with breast cancer. I also hope that all of you, whether you are at ground zero or three degrees removed from this disease, will continue to perform monthly breast self-examinations, contact a buddy to remind her to perform breast self-examinations, and support continuing efforts to combat breast cancer.
In memory of Anne Garner, RN, PhD.
NOTES
(1.) American Cancer Society, "Cancer statistics 2005: A presentation from the American Cancer Society," American Cancer Society, Inc, http://www.cancer.org/downloads/STT/ Cancer_Statistics_2005_Presentation.ppt# (accessed 14 Aug 2006).
(2.) "About breast cancer: Statistics, causes, symptoms, surgery options," breastcancer.org, http://www.breastcancer.org/ press_cancerfacts.html#statistics (accessed 14 Aug 2006).
(3.) "Statistics for 2006," American Cancer Society, Inc, http://www.cancer.org/docroot/STT/ stt_O.asp?gclid=CKSXy-CyoIYCFShFSgod8BFOtw (accessed 14 Aug 2006).
(4.) P K Bradley, "Racial and ethnic disparities in cancer care and survivorship," American Journal of Nursing 106, suppl AJN State of the Science on Cancer Survivorship (March 2006) 22-23. Also available at http://www.nursingcenter.com/library/ static.asp?pageid=623591 (accessed 14 Aug 2006).
NANCY J. GIRARD
RN, PhD, FAAN
Editor-in-Chief
COPYRIGHT 2006 Association of Operating Room Nurses, Inc.
COPYRIGHT 2006 Gale Group
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